摘要
Esophagectomy is considered the primary form of management for esophageal adenocarcinoma(EAC);however,the surgery is associated with high rates of morbidity and mortality.For patients with early-stage EAC,endoscopic resection(ER)presents a potential curative treatment option that is less invasive and carries fewer risks procedure related risks,but it is associated with higher rates of cancer recurrence following the procedure.For some patients,age and comorbidities may prevent them from having esophagectomy as a treatment option,while other patients may be operative candidates but do not wish to undergo esophagectomy for a variety of reasons related to their values and preferences.Furthermore,while anxiety of cancer recurrence following ER may significantly diminish a patient’s quality of life(QOL),so might the morbidity surrounding esophagectomy.In addition to considering health status,patient preferences,and impacts on QOL,physicians and patients must also consider what treatments would be both beneficial and available to the patient,considering esophagectomy methods-minimally invasive vs open-or the use of chemoradiotherapy in addition to ER.Our article reviews and summarizes available treatment options for patients with early EAC and their potential effects on the health and wellbeing of patients based on the current data.We conclude with a request for more research of available options for early EAC patients,the conditions that determine when each option should be employed,and their effects not only on patient health but also QOL.
Esophagectomy is considered the primary form of management for esophageal adenocarcinoma(EAC);however,the surgery is associated with high rates of morbidity and mortality.For patients with early-stage EAC,endoscopic resection(ER) presents a potential curative treatment option that is less invasive and carries fewer risks procedure related risks,but it is associated with higher rates of cancer recurrence following the procedure.For some patients,age and comorbidities may prevent them from having esophagectomy as a treatment option,while other patients may be operative candidates but do not wish to undergo esophagectomy for a variety of reasons related to their values and preferences.Furthermore,while anxiety of cancer recurrence following ER may significantly diminish a patient’s quality of life(QOL),so might the morbidity surrounding esophagectomy.In addition to considering health status,patient preferences,and impacts on QOL,physicians and patients must also consider what treatments would be both beneficial and available to the patient,considering esophagectomy methods-minimally invasive vs open-or the use of chemoradiotherapy in addition to ER.Our article reviews and summarizes available treatment options for patients with early EAC and their potential effects on the health and wellbeing of patients based on the current data.We conclude with a request for more research of available options for early EAC patients,the conditions that determine when each option should be employed,and their effects not only on patient health but also QOL.
